Patients enrolled on to the sentinel lymph node protocol will undergo a sentinel lymph node dissection as described above followed by a radical excision of the primary tumor. Patients with sentinel nodes found to contain metastatic disease from the primary vulvar malignancy will under go a complete inguinal lymph node dissection as per standard care. Patients with sentinel lymph nodes deemed negative for metastatic disease based on ultra-staging and H&E staining will be followed with conservative management (no further groin node dissection). Each of these patients will be followed clinically at 3 month intervals for the first three years for a total study follow up period of three years. Any patient determined to have a groin recurrence will be treated with current standard of care modalities as appropriate for their recurrence. Published data documenting a 5-7% unanticipated groin failures in patients with negative lymphadenectomies will be used as the comparative outcomes (25).